Spinal dural arteriovenous fistulas and intrathecal venous drainage: correlation between digital subtraction angiography, magnetic resonance imaging, and clinical findings

2012 ◽  
Vol 16 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Steven W. Hetts ◽  
Parham Moftakhar ◽  
Joey D. English ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Status ◽  
Digital Subtraction Angiography ◽  
Vertebral Body ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Mri Studies ◽  
Dural Arteriovenous Fistulas ◽  
Vessel Enhancement ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (SDAVFs) cause myelopathy through arterialization of the perimedullary venous plexus and venous congestion of the spinal cord. The authors hypothesized that the craniocaudal extent of engorgement of intrathecal draining veins between the fistula site and the point of drainage out of the thecal sac correlates with the degree of myelopathy. Methods A retrospective review of the authors' institution's radiology databases identified 31 patients with SDAVFs who had undergone digital subtraction angiography (DSA) and MRI examinations of the spine. The authors counted the number of vertebral body levels of spinal cord enhancement and intrathecal vessel enhancement on T1-weighted postcontrast MRI studies. They also counted the number of levels of cord hyperintensity and intrathecal flow voids on T2-weighted MRI studies. On DSA, the authors identified the number of vertebral body levels of dilated intrathecal draining veins and outflow points from intrathecal veins to epidural veins. Functional status of the patients at the time of diagnosis was assessed using the Aminoff-Logue scale (ALS). Results Enlargement of the intrathecal draining veins averaged 10 ± 7.7 spinal levels on DSA. Patients with enlarged draining veins extending 10 or more spinal levels on DSA had worse ALS scores (mean gait 3.4, mean micturition 1.5) than patients with draining veins extending fewer than 10 levels (mean gait 1.8, mean micturition 0.6; p = 0.009 and 0.02, respectively). The number of vertebral body levels of enlarged draining veins correlated with the ALS score (gait r = 0.42, p = 0.009; and micturition r = 0.55, p = 0.0006). More extensive enlarged draining veins were associated with more spinal cord T2 hyperintensity, T2 intrathecal flow voids, and T1 vessel enhancement but not cord enhancement. Conclusions The craniocaudal extent of enlarged intrathecal veins draining SDAVF correlates with patient functional status, providing further insight into the pathophysiology of venous hypertensive myelopathy.

Accuracy and pitfalls of multidetector-row computed tomography in detecting spinal dural arteriovenous fistulas

2010 ◽  
Vol 12 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Tetsuya Nagayama ◽  
Kuniki Eguchi ◽  
Masaaki Takeda ◽  
Kazunori Arita ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Nerve Root ◽  
Multidetector Row Computed Tomography ◽  
Digital Subtraction ◽  
Selective Angiography ◽  
Multidetector Row ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

Object The purpose of this study was to evaluate the accuracy of multidetector-row CT angiography (MDCTA) in demonstrating spinal dural arteriovenous fistulas (SDAVFs). Methods The authors studied 10 patients with SDAVFs, including 2 with spinal epidural AVFs, who underwent preoperative MR imaging, MDCTA, and digital subtraction angiography (DSA). In the evaluation of coronal sections of multiplanar reformation MDCTA images, inspection was focused on the presence of the following findings: 1) dilated perimedullary veins in the spinal canal; 2) focal enhancement of the nerve root, suggesting the location of the AVF, around the dural sleeve; and 3) a radicular vein that drains the AVF into perimedullary veins. The utility of MDCTA was assessed by comparing its findings with those of DSA in each case. Results Digital subtraction angiography confirmed that the AVFs were located in the thoracic spine in 4 patients and in the lumbar spine in 6 patients, and MDCTA detected dilated perimedullary veins in all 10 patients. In 8 patients, there was focal enhancement of the nerve root. The radicular vein that drains the AVF into the perimedullary veins was found in 8 cases. In 8 cases, the MDCTA-derived level and side of the AVF and its feeder corresponded with those shown by DSA. In 2 patients, however, the MDCTA-derived side of the feeder was on the side contralateral to the feeding artery confirmed by DSA. These lesions were interpreted as spinal epidural AVFs with perimedullary drainage. In 2 cases, MDCTA could not detect the multiplicity of their feeders. Conclusions The use of MDCTA preceding DSA can be helpful to focus the selective catheter angiography on certain spinal levels. However, one should keep in mind that epidural AVFs with perimedullary drainage may resemble SDAVFs and also that MDCTA cannot exclude the possibility of multiple feeders. Further research should elucidate how broadly selective angiography should explore around the MDCTA-suggested target.

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

2012 ◽  
Vol 32 (5) ◽  
pp. E17 ◽  
Author(s):  
Jennifer E. Fugate ◽  
Giuseppe Lanzino ◽  
Alejandro A. Rabinstein
Keyword(s):  
Spinal Cord ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Intramedullary Spinal Cord ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Signal Abnormality ◽  
Dural Arteriovenous Fistulas ◽  
Sensory Disturbances ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

Asymptomatic spinal dural arteriovenous fistulas: pathomechanical considerations

2012 ◽  
Vol 16 (5) ◽  
pp. 441-446 ◽  
Author(s):  
Kenichi Sato ◽  
Karel G. TerBrugge ◽  
Timo Krings
Keyword(s):  
Spinal Cord ◽  
Clinical Symptoms ◽  
Dorsal Side ◽  
Venous Hypertension ◽  
Venous Outflow ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients ◽  
Dural Arteriovenous Fistulas ◽  
Upper Thoracic ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (SDAVFs) consist of a shunt with converging feeding vessels arising from radiculomeningeal arteries and draining retrogradely via a radicular vein into the perimedullary veins, thereby causing progressive myelopathy due to venous hypertension in the spinal cord. The purpose of this study was to evaluate the hypothesis that the obstruction of radicular venous outlets could be an additional factor inducing symptomatic venous hypertension due to a decreased outflow in SDAVFs. Methods The authors compared the clinical and imaging findings in patients with asymptomatic SDAVFs identified incidentally at the upper thoracic region with the findings in symptomatic patients who harbored SDAVFs at the same level. Results All symptomatic patients presented with medullary dysfunction. The mean age of patients with asymptomatic SDAVF was 51.5 years, approximately 10 years younger than the patients with symptomatic SDAVF (64.1 years old). Despite the existence of dilated perimedullary vessels in the dorsal side of the spinal cord in all patients, the spinal cord edema seen in symptomatic patients was not detected on the MR images obtained in patients with asymptomatic SDAVF. The spinal angiograms of the asymptomatic patients distinctively demonstrated early radicular venous outflow from affected perimedullary veins to the extradural venous plexus as a potential alternate route for the venous hypertension to be released. Conclusions Obstruction of the radicular venous outflow could be an important factor in inducing spinal congestive edema due to venous hypertension, as well as subsequent clinical symptoms of SDAVFs.

Application of 4-Dimensional Digital Subtraction Angiography for Dural Arteriovenous Fistulas

2016 ◽  
Vol 96 ◽  
pp. 24-30 ◽  
Author(s):  
Visish M. Srinivasan ◽  
Gouthami Chintalapani ◽  
Edward A.M. Duckworth ◽  
Peter Kan
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

scholarly journals P.119 Minimally invasive surgical disconnection of a spinal dural arteriovenous fistula with the use of intraoperative digital subtraction angiography

2016 ◽  
Vol 43 (S2) ◽  
pp. S47-S48
Author(s):  
MD Staudt ◽  
B Wang ◽  
SP Lownie
Keyword(s):  
Minimally Invasive ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Thoracic Myelopathy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Minimally Invasive Surgical ◽  
Femoral Puncture ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Open Surgical Approach

Background: Spinal dural arteriovenous fistulas (dAVF) are a significant but treatable cause of progressive myelopathy. The goal of treatment is disconnection of the fistula, which is often accomplished through an open surgical approach. We report two cases using a minimally invasive surgical (MIS) approach for dAVF ligation with intraoperative digital subtraction angiography (DSA) to confirm occlusion. Methods: Case report. Results: Two patients presented with progressive thoracic myelopathy and were identified to have fistulous connections at the left L1 and T8 levels respectively. Intraoperatively, a left femoral puncture was performed and a 5-French (40 cm) sheath was inserted. Patients were positioned prone and intraoperative spinal DSA was performed using the Siemens Zeego. Once the feeding radicular artery was visualized, image overlay and cross-hair laser was used to trace and localize the fistulous zone. A unilateral single level MIS hemi-laminectomy was performed. The fistulous zone and accompanying nerve root were exposed and small hemostatic clips were applied followed by surgically disconnection. Finally, intraoperatively video angiography as well as spinal DSA were performed for confirmation. Conclusions: MIS disconnection with intraoperative DSA is a safe and effective technique for treating spinal dAVFs. Patients benefit from quicker recovery and shorter hospital stay.

Spinal Dural Arteriovenous Fistula Presenting with Myelopathy

2019 ◽  
pp. 279-286
Author(s):  
Vinayak Narayan ◽  
Anil Nanda
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Degenerative Spinal Disease ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Abstract: Spinal dural arteriovenous fistulas are a rare cause of congestive myelopathy. Symptoms are insidious in onset and may be confused with degenerative spinal disease. MRI characteristically shows edema of the spinal cord with serpiginous flow voids that follow the surface of the spinal cord. Careful evaluation with spinal angiography is required to ensure accurate diagnosis. Spinal dural arteriovenous fistulas differ from spinal arteriovenous malformations in that most fistulas have only a single fistulous point without a nidus. Spinal dural arteriovenous fistulas may be treated successfully with either surgical resection or endovascular embolization depending on their anatomy. Earlier treatment is associated with better outcomes.

scholarly journals Spinal Dural AVFs: Classifications and Advanced Imaging

2021 ◽  
pp. 129-135
Author(s):  
Michihiro Tanaka
Keyword(s):  
Spinal Cord ◽  
Imaging Modality ◽  
Thoracolumbar Spine ◽  
Venous Congestion ◽  
Advanced Imaging ◽  
Imaging Technology ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

AbstractSpinal dural arteriovenous fistulas (SDAVFs) are the most common vascular shunts of the spine. They occur predominantly in men (more than 80%), commonly involve the thoracolumbar spine, and usually cause progressive myelopathy because of venous congestion of the spinal cord. Recent advanced imaging technology can visualize the detailed angioarchitecture of the spinal cord, and this provides more information of the regional microanatomy related with the shunt disease. We retrospectively analyzed the location of the shunt with adjacent vasculatures and assessed the efficacy and the sensitivity of each imaging modality. Based on these data, a new concept of classification for SDAVFs was reviewed.

Mirror-Image Spinal Dural Arteriovenous Fistulas at the Craniocervical Junction

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. E1166-E1171 ◽  
Author(s):  
Jumpei Oshita ◽  
Satoshi Yamaguchi ◽  
Shinji Ohba ◽  
Kaoru Kurisu
Keyword(s):  
Spinal Cord ◽  
Urinary Incontinence ◽  
Computed Tomographic Angiography ◽  
Craniocervical Junction ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Mirror Site ◽  
Tomographic Angiography ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND AND IMPORTANCE We report an extremely rare case with mirror-site spinal dural arteriovenous fistulas (DAVFs) at the craniocervical junction. Although multiple spinal DAVFs have been reported in the literature, complete mirror-site lesions with fistulas and feeding arteries in the symmetric position have not been previously described. CLINICAL PRESENTATION A 74-year-old man presented with walking disturbance, urinary incontinence, and constipation progressing over a 14-month period. T2-weighted magnetic resonance imaging showed a high-intensity area in the spinal cord at the level from C4 to C6 and multiple flow voids at the surface of the spinal cord. Three-dimensional computed tomographic angiography revealed bilateral DAVFs located in the mirror site of the craniocervical junction. Direct surgery with suboccipital craniectomy and C1 laminectomy revealed dilated tortuous red veins on the dorsal surface of the spinal cord. We found bilateral symmetric red veins around the dural penetration of the vertebral artery. Both red veins were successfully interrupted with the aneurysmal clips. Postoperative 3-dimensional computed tomographic angiography revealed a disappearance of the bilateral fistulas. Magnetic resonance images obtained 6 months after the surgery confirmed the disappearance of the intramedullary high-intensity area and flow voids. The symptoms before the operation improved after surgery, especially urinary incontinence and constipation, with slight walking disturbance. CONCLUSION Because fistulas in the present case existed at the same spinal level, we found multiple fistulas on the first examination. This early notification resulted in a good outcome from the first operation. If patients with spinal DAVFs have rapidly progressing symptoms, one should suspect multiple fistulas.

scholarly journals Spinal Dural Arteriovenous Fistulas (FAVDR) with Peri- Medullary Venous Drainage: Clinical, Radiological and Therapeutic Aspects (Case Report and Literature Review)

2021 ◽  
Vol 3 (5) ◽  
pp. 32-33
Author(s):  
Tarek Mesbahi ◽  
Abderrahmane Rafiq ◽  
Nidal Amara ◽  
Marouane Makhchoune ◽  
Abdelhakim Lakhdar
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Clinical Picture ◽  
Standard Treatment ◽  
Venous Drainage ◽  
Cord Compression ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Chronic Myelopathy ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are rare and often unrecognized,  they occur predominantly in men, with an initial clinical picture most often  misleading made of chronic myelopathy in the absence of treatment, the evolution is slowly towards a definitive paraplegia. We report the case of a patient referred for a table of spinal cord compression revealing a spinal dural fistula with perimedullary venous drainage treated urgently, due to the worsening of the clinical picture. The standard treatment consists of surgical or endovascular exclusion of the fistula (in our case the fistula was surgically excluded). From this case and based on the literature, we will specify the a, clinical, radiological characteristics as well as the prognosis of these malformations, and we will discuss the possibilities of therapeutic management.

Sign in / Sign up

Export Citation Format

Share Document